In summary, you have a 2 year old girl who presented with an initial flu-like illness with fever, rash, mild hepatitis and myocarditis, had a questionable clinical response to systemic corticosteroids and now has had progressive respiratory symptoms over the last 2 months, associated with hypoxia and CXR findings of migrating patchy opacifications with a mixed air space/interstitial pattern and low lung volumes.
WHAT IS YOUR DIFFERENTIAL DIAGNOSIS AT THIS POINT?
INFECTIOUS: BACTERIAL/ SUPER BACTERIAL, MYCOPLASMA, VIRAL, FUNGAL, OPPORTUNISTIC (with history of steroid use)
INTERSTITIAL LUNG DISEASE: IDIOPATHIC OR SECONDARY TO RHEUMATOLOGICAL CONDITION, POST INFECTIOUS
WHAT WOULD YOU SUGGEST NEXT?